Development of the Nijmegen Decision Tool for chronic low back pain to guide patient triage and treatment.

Low back pain (LBP) is responsible for the greatest burden of all diseases. Chronic Low Back Pain (CLBP) is among the most common reasons why patients visit a spine surgeon. As the CLBP population is heterogeneous, it remains a challenge to address etiology and to suggest treatment options. (Inter-)National guidelines recommend to develop a decision tool to triage towards either surgical or nonsurgical interventions.

The Nijmegen decision tool, consisting of a web-based screening questionnaire, a systematic follow up of outcomes (i.e. outcome monitoring) built in the patient-based system of the SweSpine outcomes Registry, is developed to support patient-triage and is based on evidence and professional (Delphi) consensus. Since April2012 all new patients complete the questionnaire as a part of usual care, consisting of several indicators potentially predicting successful treatment outcome or persistence of pain complaints, and are systematically followed over time.


In this study pre-intervention patient profiles have been determined and a decision tool ('proof-of-principle') will be developed, based on indicators predicting successful or non-response at one-year follow-up outcome of spine surgery, of a non-surgical, multidisciplinary Combined Physical and Psychological (CPP) program and of counseling (including physical therapy in primary care). After pilot testing, the tool will be implemented in other spine clincics and externally validated.

The NDT-CLBP is a valid tool to guide treatment based on patient profiles for secondary spine care professionals

Follows usual care pathways - systematic outcome monitoring:

pre-treatment; (6 months follow up); 12 and 24 months follow up

NDT-CLBP;p decision for treatment and teratment as usual